估計糖尿病對當前及未來疾病負擔的影響:全球分析

Abstract

引言：糖尿病是一種慢性疾病，過去數十年中全球皆不斷攀升並預計將持續增加至2045年。糖尿病被認為是多種傳染病的危險因子，但糖尿病對當前和未來傳染病負擔的影響尚未得到充分評估。本研究旨在量化糖尿病對呼吸道、胃腸道和泌尿道感染負擔的貢獻，並估計三種糖尿病盛行率情境對未來負擔的影響。 方法：我們進行了三種不同情境之糖尿病盛行率預測，包括「維持現狀」的趨勢、「遏制上升」和下降至歷史盛行率最低值的情境。我們採用人群可歸因分率（PAF）模型來計算當前和未來情境中可以歸因於糖尿病的比例。我們於大型群體研究使用隨機效應模型來計算風險的綜合估計值。 結果：在2019年，糖尿病佔呼吸道感染約15.25％的DALY，佔胃腸道感染6.67％的DALY，佔泌尿道感染6.29％的DALY。高收入國家在這三種傳染病的DALY中，糖尿病所佔比例最高，而可歸因疾病的比率在撒哈拉以南非洲、南亞和拉丁美洲及加勒比地區最高。大洋洲國家是糖尿病引起的感染疾病負擔最高的國家，其中糖尿病佔呼吸道感染DALY的比例高達34.73％，而可歸因於泌尿道和胃腸道感染的DALY在最負擔國家中佔16％-18％。如果糖尿病能夠控制於2019年相同的盛行率，則可以避免超過5500萬個呼吸道感染DALY、726萬個胃腸道感染DALY和255萬個泌尿道感染DALY。 結論：於全球各地區進行糖尿病控制都具有能夠減輕胃腸道、呼吸道和泌尿道感染負擔的潛力，但效益的實際大小因國家和不同感染疾病而異。

Introduction: Diabetes mellitus is a chronic condition that has been rising globally over the past few decades, and it is projected to continue increasing into 2045. Diabetes is considered a risk factor for several types of infectious diseases, but the impact of diabetes on present and future infectious disease burden has not been well-evaluated. This study aims to quantify the contribution of diabetes on the burden of respiratory, gastrointestinal, and urinary tract infections, and to estimate the effect of three scenarios of diabetes prevalence on the future burden. Methods: We projected diabetes prevalence under three different scenarios, including a “business as usual” trend, a “stop the rise” in prevalence scenario, and a decline to the lowest historical value (a potential theoretical minimum exposure level). We used a population attributable fraction (PAF) model to calculate the proportion of disease that could be attributed to diabetes in the present and future scenarios. We calculated pooled estimates of risk from large, population-based cohort studies using a random-effects model. Results: In 2019, diabetes accounted for approximately 15.25% of respiratory infection DALYs, 6.67% of gastrointestinal DALYs, and 6.29% of urinary tract infection DALYs. Countries in Oceania were disproportionately among the countries with the highest burden of diabetes-attributable infectious disease, with diabetes accounting for up to 34.73% of respiratory infection DALYs and 16% - 18% of DALYs due to urinary tract and gastrointestinal infections in the highest-burden nations. Without intervention, diabetes-related infectious diseases will rise to account for 22% of all respiratory infections, If the rise in diabetes prevalence can be stopped at 2019 levels, more than 55 million DALYs from respiratory infections, 7.26 million DALYs due to gastrointestinal infections, and 2.55 million DALYs from urinary tract infections can be avoided. Conclusion: Diabetes control has the potential to reduce the burden of gastrointestinal, respiratory, and urinary tract infections globally and across all regions, though the magnitude of benefit varies by country and by infectious disease of interest.